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Falk-Brynhildsen, KarinORCID iD iconorcid.org/0000-0001-7862-3652
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Publications (10 of 15) Show all publications
Wistrand, C., Söderquist, B., Falk-Brynhildsen, K. & Nilsson, U. (2018). Exploring bacterial growth and recolonization after preoperative hand disinfection and surgery between operating room nurses and non-health care workers: a pilot study. BMC Infectious Diseases, 18(1), Article ID 466.
Open this publication in new window or tab >>Exploring bacterial growth and recolonization after preoperative hand disinfection and surgery between operating room nurses and non-health care workers: a pilot study
2018 (English)In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 18, no 1, article id 466Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To prevent cross infection the surgical team perform preoperative hand disinfection before dressed in surgical gowns and gloves. Preoperative hand disinfection does not make hands sterile and the surgical glove cuff end has been regarded as a weak link, since it is not a liquid-proof interface. The aims were to investigate if there were differences in bacterial growth and recolonization of hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery.

METHODS: This pilot project was conducted as an exploratory comparative clinical trial. Bacterial cultures were taken from the glove and gown interface and at three sites of the hands of 12 operating room nurses and 13 non-health care workers controls directly after preoperative hand disinfection and again after wearing surgical gloves and gowns. Colony forming units were analysed with Mann-Whitney U test and Wilcoxon Sign Ranks test comparing repeated measurements. Categorical variables were evaluated with chi-square test or Fisher's exact test.

RESULTS: Operating room nurses compared to non-health care workers had significant higher bacterial growth at two of three culture sites after surgical hand disinfection. Both groups had higher recolonization at one of the three culture sites after wearing surgical gloves. There were no differences between the groups in total colony forming units, that is, all sampling sites. Five out of 12 of the operating room nurses had bacterial growth at the glove cuff end and of those, four had the same bacteria at the glove cuff end as found in the cultures from the hands. Bacteria isolated from the glove cuff were P. acnes, S. warneri, S. epidermidis and Micrococcus species, the CFU/mL ranged from 10 to 40.

CONCLUSIONS: There were differences in bacterial growth and re-colonization between the groups but this was inconclusive. However, bacterial growth exists at the glove cuff and gown interface, further investigation in larger study is needed, to build on these promising, but preliminary, findings.

TRIAL REGISTRATION: Trial registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov ( NCT02359708 ). 01/27/2015.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Bacterial growth, Bacterial re-colonization, Cross infection, Hand disinfection, Intraoperative, Preoperative, Surgery, Surgical gloves, Surgical site infections
National Category
Infectious Medicine Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-69132 (URN)10.1186/s12879-018-3375-3 (DOI)000444938900001 ()30223772 (PubMedID)2-s2.0-85053382679 (Scopus ID)
Note

Funding Agencies:

Research Committee of Örebro County Council  

Örebro University, Sweden 

Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-04Bibliographically approved
Wistrand, C., Falk-Brynhildsen, K. & Nilsson, U. (2018). National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections. Surgical Infections, 19(4), 438-445
Open this publication in new window or tab >>National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections
2018 (English)In: Surgical Infections, ISSN 1096-2964, E-ISSN 1557-8674, Vol. 19, no 4, p. 438-445Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Surgical site infection (SSI), the third most common type of nosocomial infection in Sweden, is a patient injury that should be prevented. Methods of reducing SSIs include, for instance, disinfecting the skin, maintaining body temperature, and ensuring an aseptic environment. Guidelines for most of these interventions exist, but there is a lack of studies describing to what extent the preventive interventions have been implemented in clinical practice. We describe the daily clinical interventions Swedish operating room (OR) nurses performed to prevent SSIs following national guidelines.

METHODS: A descriptive cross-sectional study using a Web-based questionnaire was conducted among Swedish OR nurses. The study-specific questionnaire included 32 items addressing aspects of the interventions performed to prevent SSI, such as preparation of the patient skin (n = 12), maintenance of patient temperature (n = 10), and choice of materials (n = 10). The response format included both closed and open-ended answers.

RESULTS: In total, 967 nurses (43% of the total) answered the questionnaire; of these, 77 were excluded for various reasons. The proportions of the OR nurses who complied with the preventive interventions recommended in the national guidelines were high: skin disinfection solution (93.5%), sterile drapes (97.4%) and gowns (83.8%) for single use, and the use of double gloves (73.0%). However, when guidelines were lacking, some interventions differed, such as the frequency of glove changes and the use of adhesive plastic drapes.

CONCLUSION: To standardize OR nurses' preventive interventions, implementing guidelines seems to be the key priority. Overall, OR nurses have high compliance with the national guidelines regarding interventions to prevent bacterial growth and SSIs in the surgical patient. However, when guidelines are lacking, the preventive interventions lose conformity.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2018
Keywords
Patient preparation, skin disinfection, surgical site infection
National Category
Surgery Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-66708 (URN)10.1089/sur.2017.286 (DOI)000430589700001 ()29672240 (PubMedID)2-s2.0-85047351296 (Scopus ID)
Available from: 2018-04-23 Created: 2018-04-23 Last updated: 2018-10-09Bibliographically approved
Gillespie, B. M., Harbeck, E. B., Falk-Brynhildsen, K., Nilsson, U. & Jaensson, M. (2018). Perceptions of perioperative nursing competence: a cross-country comparison. BMC Nursing, 17, Article ID 12.
Open this publication in new window or tab >>Perceptions of perioperative nursing competence: a cross-country comparison
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2018 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 17, article id 12Article in journal (Refereed) Published
Abstract [en]

Background: Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses' perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room.

Methods: We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses' reported perceived perioperative competence.

Results: Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses' number of years of experience in the operating room. Nurses from Sweden with 6-10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with >10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland.

Conclusion: Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Perioperative nursing; Competence; Cross-national; Survey; Patient safety
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-66346 (URN)10.1186/s12912-018-0284-0 (DOI)000429063700001 ()29632435 (PubMedID)2-s2.0-85044847473 (Scopus ID)
Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2019-03-26Bibliographically approved
Jaensson, M., Falk-Brynhildsen, K., Gillespie, B. M., Wallentin, F. Y. & Nilsson, U. (2018). Psychometric Validation of the Perceived Perioperative Competence Scale-Revised in the Swedish Context. Journal of Perianesthesia Nursing, 33(4), 499-511
Open this publication in new window or tab >>Psychometric Validation of the Perceived Perioperative Competence Scale-Revised in the Swedish Context
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2018 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 4, p. 499-511Article in journal (Refereed) Published
Abstract [en]

Purpose: To psychometrically test the Perceived Perioperative Competence Scale-Revised (PPCS-R) in the Swedish context.

Design: Cross-sectional survey.

Methods: The 40-item PPCS-R was translated into Swedish using a forward-translation approach. A census of 2,902 registered nurse anesthetists (RNAs) and operating room (OR) nurses was drawn from a database of a national association in Sweden.

Finding: The response rate was 39% (n = 1,033; 528 RNAs and 505 OR nurses). Cronbach alpha for each factor was 0.78 to 0.89 among OR nurses and 0.79 to 0.88 among RNAs. Confirmatory factor analysis showed good model fit in the six-factor model.

Conclusions: Psychometric testing of the Swedish translation of the PPCS-R suggests a good construct validity, and the construct and its six factors are conceptually relevant among the Swedish OR nurses and RNAs.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
instrument development, nursing competence, advanced practice nursing, confirmatory factor analysis
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-56963 (URN)10.1016/j.jopan.2016.09.012 (DOI)000440398700104 ()30077294 (PubMedID)2-s2.0-85017190340 (Scopus ID)
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2019-03-26Bibliographically approved
Nilsson, U., Falk-Brynhildsen, K. & Jaensson, M. (2017). Hur har ni det med kompetensen?. In: : . Paper presented at AnIva Höstkongress 2017, 23-24 November, 2017, Upplands Väsby, Sweden,.
Open this publication in new window or tab >>Hur har ni det med kompetensen?
2017 (Swedish)Conference paper, Oral presentation with published abstract (Other academic)
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-62680 (URN)
Conference
AnIva Höstkongress 2017, 23-24 November, 2017, Upplands Väsby, Sweden,
Available from: 2017-11-19 Created: 2017-11-19 Last updated: 2019-04-05Bibliographically approved
Nilsson, U., Falk Brynhildsen, K. & Jaensson, M. (2016). Hur har ni det med kompetensen?. In: : . Paper presented at Höstkongress 2016. Riksföreningen för operationssjukvård. Stockholm, 1-2 december, 2016.
Open this publication in new window or tab >>Hur har ni det med kompetensen?
2016 (Swedish)Conference paper, Oral presentation with published abstract (Other (popular science, discussion, etc.))
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-53724 (URN)
Conference
Höstkongress 2016. Riksföreningen för operationssjukvård. Stockholm, 1-2 december, 2016
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2017-10-18Bibliographically approved
Falk-Brynhildsen, K., Söderquist, B., Friberg, Ö. & Nilsson, U. (2014). Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial sealant. European Journal of Clinical Microbiology and Infectious Diseases, 33(11), 1981-1987
Open this publication in new window or tab >>Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial sealant
2014 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 33, no 11, p. 1981-1987Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to compare microbial skin sealant versus bare skin on the leg regarding intraoperative bacterial presence in the surgical wound and time to recolonization of the adjacent skin at the saphenous vein harvesting site. A second aim was to evaluate the incidence of leg wound infection 2 months after surgery. In this randomized controlled trial, 140 patients undergoing coronary artery bypass grafting (CABG) between May 2010 and October 2011 were enrolled. Bacterial samples were taken preoperatively and intraoperatively at multiple time points and locations. OF the patients, 125 (92.6 %) were followed up 2 months postoperatively regarding wound infection. Intraoperative bacterial growth did not differ between the bare skin (n = 68) and the microbial skin sealant group (n = 67) at any time point. At 2 months postoperatively, 7/61 patients (11.5 %) in the skin sealant versus 14/64 (21.9 %) in the bare skin group (p = 0.120) had been treated with antibiotics for a verified or suspected surgical site infection (SSI) at the harvest site. We found almost no intraoperative bacterial presence on the skin or in the subcutaneous tissue, irrespective of microbial skin sealant use. In contrast, we observed a relatively high incidence of late wound infection, indicating that wound contamination occurred postoperatively. Further research is necessary to determine whether the use of microbial skin sealant reduces the incidence of leg wound infection at the saphenous vein harvest site.

Place, publisher, year, edition, pages
Springer, 2014
Keywords
intra-operative, skin sealant, saphenous vein graft harvesting, SSI, contamination
National Category
Infectious Medicine Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-32650 (URN)10.1007/s10096-014-2168-x (DOI)000344071600014 ()24907853 (PubMedID)2-s2.0-84911005344 (Scopus ID)
Note

Funding agencies are:

Research Comittee of Örebro County Council

Nyckelfonden at Örebro University Hospital

Available from: 2013-12-06 Created: 2013-12-06 Last updated: 2018-08-27Bibliographically approved
Prag, G., Falk-Brynhildsen, K., Jacobsson, S., Hellmark, B., Unemo, M. & Söderquist, B. (2014). Decreased susceptibility to chlorhexidine and prevalence of disinfectant resistance genes among clinical isolates of Staphylococcus epidermidis. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 122(10), 961-967
Open this publication in new window or tab >>Decreased susceptibility to chlorhexidine and prevalence of disinfectant resistance genes among clinical isolates of Staphylococcus epidermidis
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2014 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 122, no 10, p. 961-967Article in journal (Refereed) Published
Abstract [en]

Staphylococcus epidermidis, despite regarded as a commensal, is recognized as a nosocomial pathogen usually by acting as an opportunist, especially in infections associated with implanted foreign body materials. Pre-operative antiseptic preparation is an important strategy for reducing the risk of complications such as surgical site infection (SSI). The currently most widely used antiseptic compounds are alcohols and quaternary ammonium compounds (QACs), predominantly chlorhexidine.

The aim of this study was to investigate if decreased susceptibility to chlorhexidine among S. epidermidis was present in our setting. S. epidermidis (n=143) were obtained from prosthetic joint infections (PJI) (n=61), commensals (n=24), post-operative infections after cardiothoracic surgery (n=31), and the skin of the chest after routine disinfection prior cardiothoracic surgery (n=27). Determination of MIC of chlorhexidine was performed on Müeller Hinton agar plates supplemented with serial dilutions of chlorhexidine. Five QAC resistance genes; qacA/B, smr, qacH, qacJ, and qacG, were detected using PCR.

Decreased susceptibility to chlorhexidine was found in 54% of PJI isolates, 68% of cardiothoracic isolates, 21% of commensals, and 7% of isolates obtained from the skin of cardiothoracic patients, respectively.

The qacA/B gene was present in 62/143 isolates (43%), smr in 8/143 (6%) and qacH in one isolate (0.7%). The qacA/B gene was found in 52% of PJI isolates, 61% of cardiothoracic isolates, 25% of commensals, and 19% of isolates obtained from the skin of cardiothoracic patients. In conclusion, decreased susceptibility to chlorhexidine as well as QAC resistance genes was highly prevalent among S. epidermidis causing deep SSIs.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2014
Keywords
Staphylococcus epidermidis, chlorhexidine, prosthetic joint infection, biocide resistance, nosocomial infection
National Category
Immunology in the medical area Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-32651 (URN)10.1111/apm.12239 (DOI)000342341100008 ()24628476 (PubMedID)2-s2.0-84895913075 (Scopus ID)
Note

Funding Agency:

Örebro County Council Research Committee

Available from: 2013-12-06 Created: 2013-12-06 Last updated: 2018-06-04Bibliographically approved
Falk-Brynhildsen, K., Friberg, Ö., Söderquist, B. & Nilsson, U. G. (2013). Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes. Biological Research for Nursing, 15(2), 242-248
Open this publication in new window or tab >>Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes
2013 (English)In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 15, no 2, p. 242-248Article in journal (Refereed) Published
Abstract [en]

Surgical site contamination, for example, with coagulase-negative staphylococci, probably derives from both the patient’s own skin flora and those of the surgical team. Despite preoperative antiseptic preparation with chlorhexidine solution, complete sterilization of the skin is not possible and gradual recolonization will occur. Plastic adhesive drape is an established method used to prevent direct wound contamination from adjacent skin. In this study, the time to skin recolonization after antiseptic preparation was measured and the impact of using plastic adhesive drape on this recolonization was evaluated. Repeated bacterial sampling using three different methods over 6 hr was conducted after antiseptic preparation in 10 volunteers. Recolonization of skin was observed after 30 min with plastic drape and after 60 min without plastic drape; there were significantly more positive cultures with the plastic drape than without (31% vs. 7.5%, respectively, p < .001). Sampling with a rayon swab was the most sensitive sampling method. In conclusion, covering the skin with a plastic adhesive drape seems to hasten recolonization of the skin after antiseptic preparation. However, clinical trials to confirm this finding are warranted.

Keywords
recolonization, disinfection, plastic drape, chlorhexidine solution
National Category
Surgery Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-25334 (URN)10.1177/1099800411430381 (DOI)000314367500015 ()22278031 (PubMedID)2-s2.0-84873426936 (Scopus ID)
Note

Karin Falk-Brynhildsen is also affiliated to Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital 

Bo Söderquist i also affiliated to Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden 

Ulrica G. Nilsson is also affiliated to Department of Nursing, Umeå University, Umeå, Sweden 

Available from: 2012-08-27 Created: 2012-08-27 Last updated: 2018-05-15Bibliographically approved
Falk-Brynhildsen, K., Söderquist, B., Friberg, Ö. & Nilsson, U. (2013). Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin. Journal of Hospital Infection, 84(2), 151-158
Open this publication in new window or tab >>Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin
2013 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 84, no 2, p. 151-158Article in journal (Refereed) Published
Abstract [en]

Background: Sternal wound infection after cardiac surgery is a serious complication. Various perioperative strategies, including plastic adhesive drapes, are used to reduce bacterial contamination of surgical wounds.

Aim: To compare plastic adhesive drape to bare skin regarding bacterial growth in wound and time to recolonization of the adjacent skin intraoperatively, in cardiac surgery patients.

Methods: This single-blinded randomized controlled trial (May 2010 to May 2011) included 140 patients scheduled for cardiac surgery via median sternotomy. The patients were randomly allocated to the adhesive drape (chest covered with plastic adhesive drape) or bare skin group. Bacterial samples were taken preoperatively and intraoperatively every hour during surgery until skin closure.

Results: Disinfection with 0.5% chlorhexidine solution in 70% alcohol decreased coagulase-negative staphylococci (CoNS), while the proportion colonized with Propionibacterium acnes was not significantly reduced and was still present in more than 50% of skin samples. P. acnes was significantly more common in men than in women. Progressive bacterial recolonization of the skin occurred within 2-3 h. At 120 min there were significantly more positive cultures in the adhesive drape group versus bare skin group for P. acnes (63% vs 44%; P = 0.034) and for CoNS (45% vs 24%; P = 0.013). The only statistically significant difference in bacterial growth in the surgical wound was higher proportion of CoNS at the end of surgery in the adhesive drape group (14.7% vs 4.4%; P = 0.044).

Conclusion: Plastic adhesive drape does not reduce bacterial recolonization. P. acnes colonized men more frequently, and was not decreased by disinfection with chlorhexidine solution in alcohol.

Place, publisher, year, edition, pages
London, United Kingdom: Saunders Elsevier, 2013
Keywords
Coagulase-negative staphylococci, Contamination, Plastic adhesive drape, Propionibacterium acnes, Recolonization, Sex differences
National Category
Medical and Health Sciences Surgery Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-29852 (URN)10.1016/j.jhin.2013.02.011 (DOI)000319213200010 ()23623487 (PubMedID)2-s2.0-84878121765 (Scopus ID)
Note

Funding Agencies:

Research Committee of Örebro County Council 

Nyckelfonden at Örebro University Hospital 

Available from: 2013-06-28 Created: 2013-06-28 Last updated: 2018-09-11Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-7862-3652

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